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s <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - vwvw.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS PARCEL TAX I.D. p <br />2� 12 S.,,mm;� l�vc, 00 3�73y5'`ioZ 200 <br />LEGA LOT NO. BLOCK TRACT OR SUBDIVISION # <br />oeso. Z Z y s H <br />OWNER ADDRESS CIIYR <br />`-iY�iRCK 6�R�TliE2S!-JJJVI4S 3�{22.$1� /kVE.1JE � <br />TENANT NAME <br />CONTACT FOR PERMIT <br />� I I�fuaCk <br />l. V I'I I ItXli 1 V R �-�� <br />�-}A�RCk QRJTH4VPS �NArI 3922 8��"A�e.�c' <br />CONTR. LICENSE N� Ar�ck (3 z o i a DZ 1��� <br />USE OF BUILDING <br />N �w S F� <br />WORK DESCRIPTION <br />HEATSOURCE <br />_ Electric �Gas _ Other <br />� pµj �i+r�.� <br />, <br />NO. I TYPE OF FI%TURE OR ITEM <br />Toilet <br />Balhtub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasl�er <br />Clothes washer <br />Waler heater <br />Sink (service/bar/mop/etc.) <br />BackAow prevenler <br />Urinal <br />Drinking Foun�ain <br />Floor drein <br />Grease irap <br />Roo( drains <br />Other <br />nl <br />/D —/`�-�--/1J <br />€RMIT k <br />� �o� -6I� <br />�Z�� <br />LS 29�-Zy29 <br />�� I C� �GC�(' hN+he fS, <br />�2 S- 2�1�-i 42y <br />� � <br />CONTRACT PRICE OF WORK <br />��S K <br />135� <br />--�� ��-- <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust han <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />O�her <br />CITY OF EVERETT LOCAL SALES TAX CO�E IS J105 <br />I hereby ceiiify ihal I have read and examined Ihis applicalion and know lhe same to be irue and corred. All provisions o( laws and <br />ordinances governing ihis lype o( work will be complied with whether specified herein or not. The grenting of a permit does not presume <br />to give aulhorily to violate or cancel Ihe provision of any other state or loral law regulating consirudion or the peKormance of <br />conslruction. 117at I am aulhorized by lhe pwner of �his property to perform ihe work forwhich applicatiun is made and � wmply with Ihe <br />StakaO.rndracid-� Law 18.27 ffCW and 2gG200 WAC. <br />- Z.g- 20� <br />,'t1 w a, 5 S `Iz <br />